A recent trend in healthcare insurance is the emergence of high deductible healthcare plans. Specifically, as employers try to control year-over-year increases in providing their employees with a health insurance benefit, many small and medium-size companies are turning to health plans with higher deductible amounts. Deductibles of $1,000 for individual coverage and $2,000 for family coverage are typical of high deductible plans.
To fill the deductible gap, some employers will fund a portion of the deductible amount through a Health Reimbursement Arrangement (HRA) or Health Savings Account (HSA). With HSAs, employees can also contribute funds up to the amount of their deductible (if the plan meets IRS requirements for a high deductible plan). Another source for the payment of high healthcare coverage deductibles, are Flexible Spending Accounts (FSA) which allow the allocation of pre-tax dollars toward healthcare expenses.
In view of growing responsibility of the individual patient in monitoring and paying for health care expenses, methods and systems promoting ease of electronic access to the healthcare records are desirable, as are systems conferring the ability of the individual to easily and rapidly control the parties having access to those healthcare records.
Another recent development in the healthcare field is the implementation of the Health Insurance Portability and Accountability Act (HIPAA). Enacted by Congress in 1996, Title I of HIPAA sets forth a number of requirements addressing the security and privacy of healthcare data communicated between different covered entities, for example a healthcare provider and a healthcare insurance company.
In addition, Title II of HIPAA dictates the adoption of standardized electronic data interchange (EDI) message formats to exchange information, and the utilization of electronic forms of payment. For example, a HIPAA message type 270 (“HIPAA 270”) describes a format for an electronic benefit inquiry message sent from a healthcare provider to an healthcare insurance carrier. In turn, a HIPAA message type 271 (“HIPAA 271”) describes a format for a response to the benefit inquiry message, that is returned to the healthcare provider by the health insurance carrier. Examples of other HIPAA sections describing particular electronic message formats include a HIPAA message type 837 (“HIPAA 837”) which is a healthcare claim message to insurer, and a HIPAA message type 835 (“HIPAA 835”) which is an electronic remittance from insurer to healthcare provider. HIPAA adopts some portions of the above message formats from standards set by the American National Standards Institute (ANSI) Accredited Standards Committee (ASC). Accordingly, the HIPAA message types may refer to various portions of the ANSI standards. For example, HIPAA 271 may refer to some portion of ANSI X12N 271, HIPAA 835 may refer to some portion of ANSI X12N 835, and HIPAA 837 may refer to some portion of ANSI X12N 837.
In view of the above, banks, healthcare companies, and third party processing providers have an incentive to bring to the healthcare marketplace the degrees of reliability, interoperability, security, and automation that exists in banking and the traditional payments arena.